Ergonomic Tubing Attachment for Medical Apparatus

ABSTRACT

An ergonomic attachment system for connecting an irrigation tube or an aspiration tube to a surgical handpiece that reduces surgeon wrist fatigue due to tubing twist. The tube is connected to the handpiece through a swivel joint which allows the tube to rotate circumferentially with respect to the handpiece and self-adjust to a neutral position to relieve the twist.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of and claims priority and benefitunder 35 U.S.C. § 120 to copending U.S. patent application Ser. No.15/600,115, filed on May 19, 2017 which claims priority to and benefitunder 35 U.S.C. § 119 to U.S. Provisional Application No. 62/424,589,filed Nov. 21, 2016 and U.S. Provisional Application No. 62/340,591,filed May 24, 2016, and also to U.S. Design application 29/565,482,filed May 20, 2016 and U.S. Design application 29/580,596, filed Oct.11, 2016, the entire contents of each of which are hereby incorporatedby reference.

BACKGROUND OF THE INVENTION

The embodiments of the present invention relate generally to tubingattachment mechanisms, and more particularly, to ergonomic tubingattachments for use in medical apparatus such as ultrasonic surgicalaspirators.

Ultrasonic aspiration has become the standard of care for removal oftumors and diseased tissue in neurosurgery and general surgery.Ultrasonic aspirators are used for ultrasonic fragmentation of tissue atan operation site and aspiration of the tissue particles and fluid awayfrom the site. Typically, ultrasonic surgical aspirators include anultrasonic transducer supported within a handpiece, an ultrasonicallyvibrating horn or tip operably connected to the ultrasonic transducer,and a sleeve or flue positioned about the horn. The horn includes alongitudinally extending central bore having one end located adjacent adistal tip and a second end located adjacent the proximal end of thehorn. The proximal end of the horn is adapted to engage a vacuum sourceto facilitate aspiration of fluid. The flue is positioned about the hornto define an annular passage. Irrigation fluid is supplied through theannular passage around the horn to the surgical site where it mixes withblood and tissue particles and is aspirated through the bore in thehorn. By mixing the irrigation fluid with the blood and tissueparticles, coagulation of the blood is slowed down and aspirationthereof is aided. When the longitudinally vibrating tip in such anaspirator is brought into contact with tissue, it gently, selectively,and precisely fragments and removes the tissue. U.S. Pat. Nos. 5,015,227and 4,988,334 disclose such ultrasonic surgical devices and areincorporated herein by reference. A known ultrasonic aspirator on themarket is the CUSA EXcel® Ultrasonic Surgical Aspirator (IntegraLifeSciences Corporation, Plainsboro, N.J., U.S.A.).

Surgeons frequently need to use surgical instruments, such as handpiecesin ultrasonic aspirator systems, for long periods of time whilemaintaining dexterity. A “pencil-grip” is often employed for precisehandling. This style of gripping a long thin object is also known as the“dynamic tripod grip” in the biomechanics literature. During precisemanipulation of the instrument, a complex set of antagonistic musclesare employed in the human hand to control shaking and maintain thedesired trajectory of the surgical instrument.

The energy stored in twisting an elastomeric tube can be quite large.For example, a toy aircraft can be powered by the energy stored in thetwist of an elastic band for up to several minutes on a single winding.In the case of the surgical handpiece, due to the length of the tubinggoing from the handpiece to the instrument console or wall vacuumoutlet, the elastic energy stored in the tubing can be large even forsmall twist angles. Also, as the tubing is handed over from theassistant to the surgeon or between multiple surgeons operatingsimultaneously, the tubing can get progressively wound up requiring thesurgeon to provide more and more opposing force to keep the tool tipfrom rotating. If a dynamic mechanism to alleviate the torque is notprovided, the ergonomic situation can get progressively worse. Thelength of tubing that is not directly used can be coiled and placed inthe vicinity of the surgical field. The act of coiling and uncoiling canalso build up twist.

In recent years, the surgical community has gradually moved from opensurgery to laparoscopic surgery (also known as Minimally InvasiveSurgery or MIS) for certain surgical procedures. In this modality ofsurgery, the grip style of surgical instruments is slightly different

-   -   it is more like grasping a screwdriver, rather than a        pencil-like grip. In this style of grip, the rotation or torque        of the instrument is even more prominent than in the pencil-like        grip.

The fact that ergonomics of existing instruments are poor has beendocumented by surgeons. For example, Berguer et al. have observed thatsurgeons reported increased upper-extremity fatigue and occasional handnumbness after laparoscopic procedures (Surgical Endoscopy (1999) 13:466-468). Franasiak and Gehrig have reported that recent data on MISsurgeons indicate very high rates of surgeon strain, 88% when roboticassistance is not used, and identify instrument design as a majorconcern (J. of Clinical Outcomes Management (2015) 22(6): 267-273).

There are many different parameters that confound the factors that canbe studied in attempting to design surgical instruments and tubingattachments to alleviate surgeon fatigue in prolonged use. Attempts havebeen made, for example, by reducing the stiffness of the tubing whilemaintaining non-kinkability, or by keeping the flexibility of the tubingwhile keeping the stiffness high.

U.S. Pat. No. 8,211,103 discloses an electrosurgical instrument with anadjustable power cable. The electrosurgical instrument includes a handpiece that is connected to an electrosurgical generator by way of anelectrical cable. The hand piece includes a channel system that receivesa portion of the electrical cable therein and allows a physician toadjust the location on the hand piece at which the electrical cableexits the hand piece.

U.S. Patent Application Publication No. 2008/0200884A1 describes anophthalmic surgical instrument that includes a reinforcement structure,such as ribs, on the outer surface of the irrigation tubing to resistkinking of the tubing during surgery.

However, prior art does not recognize that a significant portion of thefatigue is due to the rotational twist of the tubing. Prior art hasfailed to identify this major factor associated with surgicalinstruments that adds to the surgeon fatigue problem and has notprovided satisfactory solutions.

Hence, those skilled in the art have recognized a need for ergonomicsurgical instruments that alleviate surgeon fatigue in prolonged use.The embodiments of the present invention fulfill this need and others.

SUMMARY OF THE INVENTION

It has been identified that a significant portion of surgeon fatigue inprolonged use of surgical instruments is due to the rotational twist ofthe tubing. The torque of the tubing attachments provides a resistanceto rotation that the surgeon has to continuously oppose. An advantage ofthis invention is the elimination of such twist.

Briefly and in general terms, some embodiments of the present inventionprovide mechanisms in a tubing attachment joint design to dynamicallyneutralize this twist. The first mechanism is a molded swivel joint thatcan be snapped into a groove of a luer device. The swivel extends outfrom the center where a cradle is provided to capture one tube. Thisgeometry allows the tubing to rotate without twisting eliminating theneed for surgeons to resist twist. The second mechanism is the pairedchoice of materials and geometric tolerances between the tubing innerdiameter and a male luer fitting. The design is such that vacuum leaksare not formed while the tubing can rotate in the joint with very littleapplication of rotational moment. Thus the twist in the vacuum tubingcan be eliminated regardless of coiling of the remaining length of thetubing.

In some embodiments of the invention, for example, a tubing attachmentsystem for use in a medical apparatus having a handpiece and a tube tobe connected proximally to the handpiece may comprise a tubingattachment component having a proximal end, a distal end and an externalsurface. In some embodiments, the tubing attachment component maycomprise a proximal end portion configured to attach to the tube, adistal end portion configured to attach to the handpiece, a throughboreextending from the distal end to the proximal end, and a circumferentialgroove on the external surface between the proximal end portion and thedistal end portion. In various embodiments, the tubing attachment mayinclude a capture component comprising a frame that has an internalframe surface, an external frame surface, and a frame opening forreceiving the tubing attachment component. Moreover, in someembodiments, the frame may comprise at least one locking protrusionextending inward from the internal frame surface. In variousembodiments, the frame and the at least one locking protrusion may beconfigured to fit in the circumferential groove and may be rotatable inthe circumferential groove about the tubing attachment component when anexternal force is applied and to frictionally lock the tubing attachmentcomponent in a desired rotational position in the absence of suchexternal force.

In addition, in various embodiments, the capture component may have atleast three of the locking protrusions disposed on the internal framesurface of the frame with contact surfaces facing inward. In variousembodiments, the external force may be intentionally applied by a userto rotate the frame about the tubing attachment component, or is causedby coiling of the tube attached to the proximal end portion of thetubing attachment component. Moreover, in various embodiments, thecoiling of the tube may produce the external force, which causes thecapture component to rotate about the tubing attachment componentwhereby the tubing attachment system self-adjusts to a neutral positionto relieve the coiling of the tube. In some embodiments, the proximalend portion may comprise a conical body transitioning into a radiallyoutwardly extending barb for securing the tube, and the distal endportion may comprise a fitting for engaging a corresponding fitting onthe handpiece. In various embodiments, the tubing attachment componentmay comprise a flange between the conical body and the fitting, and theflange may form a rail of the circumferential groove. Moreover, in someembodiments, the capture component may comprise a pair of arms extendingoutwardly from the external frame surface forming a channel for holdinganother tube. In various embodiments, the tubing attachment system is incombination with a medical apparatus. Moreover, in some embodiments, themedical apparatus may be an ultrasonic surgical apparatus.

In some embodiments, a medical apparatus may include a handpiece and atube. Moreover, in various embodiments, the tube may be connected to thehandpiece through a swivel joint which allows the tube to rotatecircumferentially with respect to the handpiece without axialdisplacement of the tube.

In addition, in various embodiments, the swivel joint may include atubing attachment component comprising a longitudinal throughbore and acircumferential groove on an external frame surface. In someembodiments, the swivel joint may include a capture component comprisinga frame with a frame opening and at least one locking protrusionextending inward from an internal frame surface of the frame. Moreover,in some embodiments, the frame may be snapped into the circumferentialgroove of the tubing attachment component and rotate about the tubingattachment component. In various embodiments, the at least one lockingprotrusion may allow the capture component and tubing attachmentcomponent to be fixed at a desired relative position. In someembodiments, the capture component may have at least three lockingprotrusions extending radially inward from the internal frame surface ofthe frame. Moreover, in various embodiments, the tubing attachmentcomponent may further comprise a flange extending from the externalframe surface of the tubing attachment component. In some embodiments,the capture component may comprise a pair of arms extending outwardlyfrom the external frame surface forming a channel for holding anothertube. In some embodiments, the swivel joint may allow the tube, whentwisted, to self-adjust to a neutral position to relieve the twist ofthe tube. In various embodiments, the medical apparatus may be anultrasonic surgical apparatus. In addition in some embodiments, the tubemay be an irrigation tube or an aspiration tube.

In various embodiments, a tubing attachment system for use with anultrasonic surgical apparatus having a handpiece and an aspiration tubeto be connected proximally to the handpiece, wherein the tubingattachment system may comprise a tubing attachment component. The tubingattachment component may comprise a longitudinal throughbore and acircumferential groove on an external frame surface. In someembodiments, the tubing attachment component may comprise a proximal endportion configured to attach to the aspiration tube and a distal endportion configured to attach to the handpiece. In some embodiments, thetubing attachment system may include a capture component comprising aframe having a front side and an opposing back side and a longitudinalframe opening extending between the front side and the back side. Invarious embodiments, the longitudinal frame opening may be defined by aplurality of locking protrusions, each locking protrusion may have aproximal end and a distal free end, wherein the proximal end projectsfrom the frame adjacent the front side and the distal free end adjacentthe back side. In some embodiments, each locking protrusion may narrowthe longitudinal frame opening from the front side to the back side.Moreover, in some embodiments, the frame between the front side of theframe and the distal free ends of the plurality of locking protrusionsmay be longitudinally held between the longitudinal extent of thecircumferential groove of the tubing attachment component while allowingrotation of the capture component about the tubing attachment component.In various embodiments, the plurality of locking protrusions may allowthe capture component to rotate about the tubing attachment componentwhen a threshold external force is applied to the tubing attachmentcomponent.

In addition, in various embodiments, the capture component may furthercomprise a channel at a radial position away from the longitudinal frameopening for holding one or more tubes. In some embodiments, the tubingattachment system may be in combination with an ultrasonic surgicalapparatus that has a handpiece and an aspiration tube connected to theproximal end portion of the tubing attachment component. In variousembodiments, the tubing attachment component may further comprise atleast one flange extending from the external frame surface of the tubingattachment component to define the longitudinal extent of thecircumferential groove. In some embodiments, each of the lockingprotrusions include contact surfaces facing inwardly that extend fromthe proximal end to the distal free end of the locking protrusion.

In accordance with aspects of the invention, there is provided a tubingattachment system for use in a medical apparatus having a handpiece anda tube to be connected proximally to the handpiece. The tubingattachment system comprises a tubing attachment component and a capturecomponent. The tubing attachment component has a proximal end, a distalend and an external surface, and comprises a proximal end portionconfigured to attach to the tube, a distal end portion configured toattach to the handpiece, a throughbore extending from the distal end tothe proximal end, and a circumferential groove on the external surfacebetween the proximal end portion and the distal end portion. The capturecomponent comprises a frame having an internal frame surface, anexternal frame surface, and a frame opening for receiving the tubingattachment component, the frame comprising at least one lockingprotrusion extending inward from the internal frame surface. The frameand the at least one locking protrusion are configured to fit in thecircumferential groove and be rotatable in the circumferential grooveabout the tubing attachment component when an external force is appliedand to frictionally lock the tubing attachment component in a desiredposition in the absence of such external force. There may be two or atleast three locking protrusions extending radially inward from aninternal surface of the frame. The external force may be intentionallyapplied by a user to rotate the frame about the tubing attachmentcomponent, or may be caused by coiling of the tube attached to theproximal end portion of the tubing attachment component. The externalforce required to rotate the frame may be predetermined or adjustedbased on the friction provided by the locking protrusions. For example,the external force required may be very low so that the system canself-adjust to a neutral position to relieve tubing twist.

In more detailed aspects, the proximal end portion comprises a conicalbody transitioning into a radially outwardly extending barb for securingthe tube, and the distal end portion comprises a fitting for engaging acorresponding fitting on the handpiece.

In accordance with other aspects of the invention, there is provided amedical apparatus comprising a handpiece and a tube, wherein the tube isconnected to the handpiece through a swivel joint which allows the tubeto rotate circumferentially with respect to the handpiece without axialdisplacement of the tube. The swivel joint may comprise a tubingattachment component comprising a longitudinal throughbore and acircumferential groove on its external surface; a capture componentcomprising a frame with a frame opening and locking protrusionsextending radially inward from an internal surface of the frame; whereinthe frame can be snapped into the circumferential groove of the tubingattachment component and rotate about the tubing attachment component;and wherein the locking protrusions allow the capture component andtubing attachment component to be fixed at a desired relative position.

In further detailed aspects, the tubing attachment component may furthercomprise a flange, for example an annular flange, between the conicalbody and the fitting, and the flange may form or serve as a rail of thecircumferential groove. The capture component may further comprise apair of arms extending outwardly from the external frame surface forminga channel for holding another tube. The arms may be a pair of curvedarms forming an inward facing channel for receiving a tube. Additionalarms may be provided, extending from the external frame surface or froman arm, to hold one or more additional tubes, wires or accessories.

Other features and advantages of the embodiments of the presentinvention will become more apparent from the following detaileddescription of the invention, when taken in conjunction with theaccompanying exemplary drawings.

BRIEF DESCRIPTION OF THE DRAWINGS

In the drawings, like reference characters generally refer to the sameparts throughout the different views. Also, the drawings are notnecessarily to scale, emphasis instead generally being placed uponillustrating the principles of the invention.

Embodiments of the presently disclosed shear stress ultrasonic horn aredescribed herein with reference to the drawings, in which:

FIG. 1 is a perspective view of an ultrasonic apparatus in accordancewith an embodiment of the present invention;

FIG. 2 illustrates the proximal end of the apparatus of FIG. 1 in moredetail and additionally includes a detailed view of the capturecomponent;

FIG. 3 is a perspective view a nosecone fully assembled to a handpieceand supporting the flue (the flue or flue tube is not shown in thisdrawing);

FIG. 4 is a cross-sectional view of a portion of the ultrasonicapparatus of FIG. 1;

FIG. 5 is a perspective view of an ultrasonic horn;

FIG. 6A illustrates a tubing attachment system of an embodiment of thepresent invention in a dissembled state;

FIG. 6B illustrates the tubing attachment system of FIG. 6A in anassembled state;

FIG. 7A illustrates the tubing attachment system of FIG. 6A and ahandpiece in a assembled state;

FIG. 7B illustrates the elements shown in FIG. 7A in a disassembledstate;

FIG. 8 is a front perspective view of a capture component in accordancewith an embodiment of the present invention;

FIG. 9 is a rear perspective view of the capture component of FIG. 8;

FIG. 10 is a front elevational view of the capture component of FIG. 8;

FIG. 11 is a rear elevational view of the capture component of FIG. 8;

FIG. 12A is a rear view of another embodiment of a capture component ofan embodiment of the present invention with dimensions shown in inches;

FIG. 12B is a cross-sectional view taken along line YZ-YZ of FIG. 12A;

FIG. 13 illustrates an alternative embodiment of a tubing attachmentsystem of an embodiment of the present invention in an assembled andconnected state and additionally includes a detailed view of the capturecomponent;

FIG. 14 illustrates another alternative embodiment of a tubingattachment system of an embodiment of the present invention in anassembled and connected state and additionally includes a detailed viewof the capture component;

FIG. 15 illustrates a further alternative embodiment of a tubingattachment system of an embodiment of the present invention in anassembled and connected state;

FIG. 16 illustrates an embodiment of a tubing attachment componentassembled in a medical apparatus and other tubing connectors;

FIG. 17 illustrates further embodiments of a tubing attachment componentand a capture component assembled in a medical apparatus;

FIG. 18 illustrates the tubing attachment component and capturecomponent shown in FIG. 17 with a different rear cap component in theassembly;

FIG. 19A illustrates a prior art tubing connection architecture;

FIGS. 19B and 19C illustrate various embodiments of tubing connectionarchitectures;

FIGS. 20A, 20B, 20C, 20D, and 20E illustrate additional alternativeembodiments of tubing connection architectures;

FIG. 21A is a perspective view of a tubing cartridge in accordance withan embodiment of the present invention;

FIG. 21B is an assembly showing the path of the irrigation andaspiration tubing within the cartridge;

FIG. 21C is an assembly drawing showing aspiration and IV connectors onthe right;

FIGS. 22A, 22B, 22C, 22D, 22E, and 22F show a step-by-step process ofconnecting a cartridge and tubing set of an embodiment of the presentinvention to a handpiece; and

FIGS. 23A, 23B, 23C, and 23D show a step-by-step process of connecting acartridge and tubing set of an embodiment of the present invention to aconsole of an ultrasonic aspirator.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

Embodiments of the presently disclosed tubing attachment system will nowbe described in detail with reference to the drawings, in which likereference numerals designate identical or corresponding elements in eachof the several views. As used herein, the term “distal” refers to thatportion of the instrument, or component thereof which is farther fromthe user while the term “proximal” refers to that portion of theinstrument or component thereof which is closer to the user duringnormal use. The terms “ultrasonic horn,” “ultrasonic tip,” “ultrasonicaspirating tip,” “ultrasonic surgical aspirating tip,” “aspirating tip,”“ultrasonic surgical tip,” “surgical tip”, “horn” and “tip” are usedherein interchangeably. The terms “tube” and “tubing” are used hereininterchangeably. The terms “capture component,” “tube clip,” “tubingclip,” “flue tube clip,” “flue tubing clip,” “flue irrigation tubeclip,” and “flue irrigation tubing clip” are used hereininterchangeably.

It has been found that precise pronation and supination or rotatingduring pencil grip is an aspect of tool handling that results in greaterfatigue in surgeons than other manipulations such as changing the yaw orpitch of the instrument orientation. This could be because of the needto use weaker finger muscles to rotate an instrument, while othermovements can leverage the larger wrist muscles. It has also beenidentified that the torque of the tubing attachments provides aresistance to rotation that the surgeon has to continuously oppose. Thefatigue in rotational movement is often accentuated by the presence ofcables and tubing attachments present in electromechanical surgicalinstruments.

Three sets of attachments are usually present in the ultrasonic surgicalapparatus—irrigation tubing to supply irrigant to surgical site,aspiration tubing to provide suction, and electrical wires to power theinstrument or provide switching connections. A particularlyobjectionable aspect of these attachments is the torque provided by thetwisting of the tubing and cables, which the surgeon has to constantlyovercome to maintain precise trajectory of the instrument. Inelectromechanical surgical handpieces, the torque due to the torsionaltwisting of tubing and cable attachments has been identified in anembodiment of the present invention as a major contributor to surgeonfatigue.

Referring now to FIGS. 1-4, one embodiment of the presently disclosedapparatus for ultrasonically fragmenting and aspirating tissue is shown.Generally an ultrasonic surgical apparatus 10 includes a handpiece 12for use by a surgeon to direct fragmentation. The handpiece 12 encases atransducer (not shown) on which a surgical tip or ultrasonic horn 14 isfastened. The ultrasonic horn can be powered by the transducer and beultrasonically actuated to fragment tissue and suction effluent via acentral channel. A distal end portion 13 of the ultrasonic horn 14extends beyond a distal end of the flue 16. Ultrasonic horn 14 isvibrated to fragment tissue during surgery. The ultrasonic horn may bemade of titanium or other conventional materials known in the art.

A cooling and irrigation system which provides cooling fluid to theultrasonic horn 14 is provided for maintaining temperature within anacceptable range. The handpiece 12 includes a housing 15, which may beformed of a sterilizable plastic, metal or other suitable materials or acombination thereof. The flue 16 provides a path for irrigation fluid orliquid and connects to the distal end of the housing 15. The flue 16typically connects to the handpiece 12 via a nosecone 32. The flue 16may include or attach to a flue tube 18. The nosecone 32 connects to thehandpiece 12 and covers the internal portion of the ultrasonic horn 14.

An irrigation tube 22 connects to the flue tube 18 up-stream andsupplies irrigation fluid through the flue tube 18 to an operative siteduring surgery. An aspiration tube 24 provides suction and a path foraspiration from the operative site to a collection canister (not shown).Alternatively, the aspiration tube may be mounted outside of the housing15. A flue tube clip or capture component 19 allows for adjustment ofthe location of the flue tube 18 per the desires of the surgeon duringoperation. An electrical cable 26 provides power to the apparatus orprovides switching connections.

FIG. 5 illustrates an embodiment of an ultrasonic tip or ultrasonic horn14, which is suitable for use with the above-described ultrasonicsurgical apparatus for fragmenting and aspirating tissue. The ultrasonichorn includes a first horn extender 116 and a second horn extender 118extending distally from the first horn extender through a horn extendertransition segment 112. The ultrasonic horn 14 may have a third hornextender and additional horn extenders. The ultrasonic horn has a distalend portion 113 and a threaded proximal end 111, a throughbore 117, apreaspiration hole or transverse bore 115, and a hexagon engagementportion 119. The ultrasonic horn has a larger diameter in the first hornextender 116 section and a smaller diameter in the second horn extender118 section. Although the ultrasonic horn as shown is a stepped horn, itis known that there are ultrasonic horns that are not stepped. Forexample, the ultrasonic horns can have a single long extender, ratherthan two diameters, and the single long extender can have a constantdiameter throughout its length or have a gradually changing diameteralong its length, for example, gradually decreasing in diameter alongits length distally. In addition, even though two extenders may form astepped configuration, additional extender or extenders may formadditional steps or transition smoothly from another extender withoutforming any apparent step. The ultrasonic horn may vibrate in theultrasonic frequency range with a longitudinal amplitude in excess ofabout 5 mils (0.005 inch) to 14 mils (0.014 inch).

The ultrasonic horn 14 is substantially circular and disposed within theflue 16. During operation of the ultrasonic apparatus 10, irrigationfluid is supplied through the irrigation tube 22 and flue tube 18 intothe flue 16. The flue 16 and the ultrasonic horn 14 define an annularcavity 36 therebetween. Irrigation fluid is supplied from flue 16through cavity 36 to the distal end of the ultrasonic horn 14. Atransverse bore is formed in preaspiration holes 115 near the distal endof the ultrasonic horn 14 and communicates with the throughbore 117. Theirrigation fluid is drawn from preaspiration holes 115 and the surgicalsite into inlet 31 of the throughbore 117 along with fragmented tissue,blood, etc., and is removed from the surgical site via the throughbore117 and the aspiration tube 24. The transverse bore provides analternate route for fluid to enter throughbore 117 when inlet 31 becomesclogged.

In a more detailed aspect, irrigation liquid, for example saline, isnecessary to cool the surgical tip and site of tissue fragmentation.This irrigation liquid is provided to the flue with a peristaltic pumpat a rate as low as 2 to 3 ml/min, which is only typically about a dripor two a second. The irrigation liquid is supplied at the proximal endof the ultrasonic horn. The irrigation liquid progresses to near thedistal end of the ultrasonic horn, where two preaspiration holes, whichmay each have a 0.015 inch diameter for example, suction a majority,perhaps 90-95%, of the irrigation through the holes connecting theoutside horn diameter to the central suction channel. This action ofirrigation and suction supports a contiguous cooling circuit for thevibrating titanium metal and it also helps to wet effluent such as bloodand tissue in the central channel. Some irrigation is also favorable tocooling the surgical site, improving coupling to tissue, and affordingcavitation necessary to emulsification and aspiration of tissue, such astumors.

Referring now to FIGS. 6A, 6B, 7A and 7B, a swivel joint or tubingattachment system 40 comprises a tubing clip or capture component 42 anda tubing attachment component 44. The capture component 42 comprising aframe 421 having a frame opening 423 that allows a tube or the tubingattachment component 44 to go through. The frame 421 has lockingprotrusions (or locking teeth or fingers) 425 that hold or grip the tubeor tubing attachment component in a desired position. The lockingprotrusions may be extending radially inward from an internal framesurface 424 of the frame 421. The tubing capture component 42 also hastwo arms 427 that extend from the frame 421 and are able to hold anothertube, such as the flue tube or irrigation tube, a cable or otheraccessory in a desired position relative to the aspiration tube orsuction tube. The two arms 427 may be curved towards each other, forminga channel 429 allowing a tube, cable or accessory to be retained,inserted and/or retained between the two arms. The capture component 42allows a user to clock the flue tube at any position as desired. One ormore additional arms may be provided, extending from an external framesurface 426 or from an arm 427, to hold one or more additional tubes,cables or accessories.

The frame 421 and locking protrusions 425 are configured to fit in thecircumferential groove 447. The capture component 42 may be snapped ontoan extended section of the tubing attachment component 44 allowingrotation to neutralize torque. For example, the frame 421 can be snappedinto the circumferential groove 447 of the tubing attachment component44 and rotate about the tubing attachment component 44 when an externalforce is applied and to frictionally lock the tubing attachmentcomponent in a desired position in the absence of such external force.The external force may be intentionally applied by a user to rotate theframe about the tubing attachment component, or may be caused by coilingof the tube attached to the proximal end portion of the tubingattachment component. The external force required to rotate the framemay be predetermined or adjusted based on the friction provided by thelocking protrusions. For example, the external force required may beextremely low so that the system can self-adjust to a neutral positionto relieve tubing twist. The locking protrusions 425 allow the capturecomponent and tubing attachment component to self-adjust and be fixed ata desired relative position, for example, a neutral position withouttubing twist.

The tubing attachment component 44 has a conical body 444 with one ormore radially outwardly extending barb 442 such as a hose barb, a flange448 such as an annular flange, a plug or male fitting (male luerfitting) 446, and a central bore 441 formed through the tubingattachment component from the proximal end to the distal end. In oneembodiment, a circumferential groove 447 is formed on the externalsurface of the tubing attachment component between the plug or malefitting 446 and the flange 448. The flange may be an annular flange.

The capture component 42 and the tubing attachment component 44 may bemanufactured by injection molding and can be press-fitted together tocreate a tubing attachment system 40. In an assembled state, the capturecomponent 42 is freely rotatable in the circumferential groove 447provided on the tubing attachment component 44. Locking protrusions 425are provided so that the assembly cannot be disassembled once fitted.The larger aspiration tube 24 slides into the barb 442 such that it isvery difficult to remove the aspiration tube 24 once fitted. The freelyrotating tubing attachment alleviates tubing twist. The electrical cable26 has a small outer diameter, is located off-center from the axis ofrotation, and is made with materials that provide enhanced flexibility.Socket or female fitting (female luer fitting) 122 on the handpieceforms an irrigation port for receiving the plug or male fitting (maleluer fitting) 446.

FIGS. 8-11 show a capture component 542 of an embodiment of the presentinvention in more detail. The capture component 542 has a plurality oflocking protrusions (or locking teeth or fingers) 525 disposed on theframe 521 extending inwardly, and two arms 527 curved towards each otherfor holding another tube, wire or other accessory. The lockingprotrusions 525 may be extending from an internal frame surface 524 ofthe frame 521, for example, extending from an internal frame surface 524opposing the front surface 529 of the capture component 542, orextending radially inwardly from an internal frame surface 524 opposingthe external frame surface 526 of the frame 521. Each locking protrusionhas side walls 528 and a contact surface 522 facing a frame opening 523.The contact surface 522 of the plurality of locking protrusions 525collectively provide adequate friction for holding or griping a tube ortubing attachment component received in the frame opening 523. Theamount of torque needed to rotate the capture component 542 about atubing attachment component may be established or changed by employingdifferent numbers, geometries and/or materials of the lockingprotrusions, or by varying the curvatures or sizes of the contactsurfaces of the locking protrusions. The frame has at least one lockingprotrusion, for example, 3-10 locking protrusions or preferably 4-8locking protrusions. The locking protrusions may be integrally molded,fixedly connected or removeably attached to internal surface of theframe.

FIG. 12 shows another embodiment of a capture component of the presentinvention. This capture component 642 embodiment has 8 lockingprotrusions, whereas the embodiment shown in previous drawings has 6locking protrusions.

Although the frame of the capture component is shown to have a generallycircular internal circumference and a generally circular externalcircumference, it is understood that the capture component in itsentirety or the frame may have different configurations and shapes onits external surface and/or its internal surface, so long as theinternal locking protrusions are arranged in a way that functions as aswivel joint in accordance with an embodiment of the present invention.Likewise, the locking protrusions may have different configurations,heights, widths or shapes so long as they jointly provide adequatefriction to allow the swivel joint to rotate when an external force isapplied and to frictionally lock the tubing attachment component in adesired position in the absence of such external force.

FIGS. 13-18 illustrate additional variations of the capture componentand/or the tubing attachment component in their general configurationswithout showing the locking protrusions of the capture component. FIG.13 shows embodiments of a capture component 142 and a tubing attachmentcomponent 144. The molded tubing clip or capture component 142 isassembled to or about an aspiration tube 24 to bundle the aspirationtube and irrigation tube, power cord and CEM along the length of thetubing set. The tubing attachment component 144 has a flange 148positioned distally to the capture component 142 in an assembled state.

FIG. 14 shows another alternative embodiment of a tubing attachmentcomponent 244. It has a flange 248 positioned proximally to the capturecomponent 142 in an assembled state.

FIG. 15 shows another embodiment of a capture device 242. The capturecomponent is assembled to the end of the flue tube, clips on to theaspiration tube luer fitting or tubing attachment component 244. Theflue would have a shorter length of flue tube and a custom connector forconnection with the irrigation tube.

The swivel joint formed by the tubing attachment component and thecapture component allows the tube to rotate circumferentially withrespect to the handpiece without axial displacement of the tube.Although exemplary embodiments are described herein, it is contemplatedthat swivel joints with other configurations or mechanisms, includingbut not limited to commercially available swivel joints, may be usedwithout departing from the spirit of the present invention.

FIG. 16 shows a female luer lock flue tube fitting 345 assembled to anend of the flue tube. It may be stretched slightly and clips onto therear nut 343. An annular groove 347 is machined into the rear nut andprovides a channel to accept the flue tube fitting. The flue has ashorter length of flue tubing than the flue tubing as shown in FIG. 15.

FIG. 17 shows that a ring 535 with a clip is trapped by a rear cap 547and can rotate to accept a flue tube in any position. The durable moldedrear cap is snapped on to the rear nut semi-permanently to protect thepotting from staining.

FIG. 18 shows a disposable molded rear cap 647, with a dog house cut outfor power cord. It is snapped on to rear nut to protect the potting fromstaining. The rear cap 647 may be assembled to the aspiration tube, butstill allows the tubing attachment component to be rotated to alleviatetorque. A C-clip 637 with a clip for flue tube is snapped onto a groovein the disposable rear cap.

FIGS. 19A-C illustrate various embodiments of tubing connectionarchitectures. The tubing connection in FIG. 19A shows a prior arttubing connection architecture that does not have any swivel accordingto an embodiment of the present invention. FIG. 19B illustrates that theswivel joint of an embodiment of the present invention is present in thesuction line only. FIG. 19C illustrates that the swivel joint applies toboth the suction and irrigation tubing connections. The swivel joint ofan embodiment of the present invention may be present in thesuction/aspiration tubing connection and/or the flue tubing andirrigation tubing connection. The swivel joint may also be present onthe power cable connection.

As shown in FIGS. 20A-E, the flue, flue tube, and irrigation tube may beconnected in various configurations. For example, the flue tube mayconnect to the irrigation tube at a point proximal to the handpiece,near to the rear cap of the handpiece, or near the flue, or at a suctionconnector or a stationary portion of a tubing connector. Alternatively,the irrigation tube may connect directly to the flue, without the needfor a flue tube. The flue tube may be captured in a slot that runs alongthe entire length of the handpiece or along a portion of the length ofthe handpiece. Each of the various embodiments include a swivel joint740. FIG. 20A shows that the flue tube connects to the irrigation tubedown-stream and captured in a slot along the length of the handpiece.FIG. 20B shows that the flue tube connects to the irrigation tube at astationary portion of the tubing connector. FIG. 20C shows that the fluetube connects to the irrigation tube at a suction connector (serviceloop). FIG. 20D shows that the flue tube connects to the irrigation tubea suction connector in a different way (exposed flue tube). FIG. 20Eshows that the irrigation tube connects to the flue.

Suitable materials for making the tubing attachment component andcapture component including locking protrusions, include, but are notlimited to, natural or synthetic materials, for example, metal,polymeric or thermoplastic materials. Examples include silicone, nylon,polypropylene, polycarbonate, polytetrafluoroethylene (PTFE),polyetheretherketone (PEEK), polyetherimide (PEI) resins,polyphenylsulfone (PPSU), or polysulfone, or other materials known tothose skilled in art, or combinations of the above. The capturecomponent can be made by injection molding or other conventionalmanufacturing methods. The components and portions thereof may be madeof different materials. It may be preferred to use durable materialsthat can survive steam sterilizations or other sterilization processes.The components may be made of low cost materials for use as disposablecomponents.

The materials of the tubing and locking protrusions and their finishesare chosen such that the friction between the surfaces is minimal andthe tubing can freely rotate on the hose barb even under the vacuum ofaspiration. Additional materials and structures of tubing may bedeveloped or selected to reduce twisting. It is also possible to providedynamic relief of twisting using biomimetic tubing design and/ornano-structured surface finish to reduce friction.

The tubing attachment system or assembly of an embodiment of the presentinvention has many advantages. With respect to ergonomics, the tubingattachment provides neutralization and adjustment of force due to twistof tubing which was identified as a major factor in surgeon fatigueinvolving muscles of the thumb, other fingers and wrist. In addition,connectors may be made of plastic which is light weight compared tometal luer fittings used in prior art and the coefficient of frictionbetween the tubing silicone and connector polymer can be tuned bymolding surface finish to create low torsional resistance to dynamicadjustment. Furthermore, irrigation and aspiration connectors can begathered together for ease of tubing management while their rotationalorientation can be independently adjusted for comfort. With respect toelectrical safety for electrosurgical or combination electrosurgical andultrasonic handpieces, the connectors may be made of non-conductingplastic which results in simpler design for electrosurgical devices withhigh voltage that can be induced or conduced in metal parts. Withrespect to manufacturing cost, connectors can be molded at high volumeat minimal cost such that they can be disposable.

The tubing attachment system and swivel joint described above could beuseful for ultrasonic surgical apparatus, electrosurgical apparatus,rotational drill type instruments, or other instruments, whether poweredor not, that have tubing such as irrigation tubing or aspirating tubing,wiring or cables.

In addition to the tubing attachment to the handpiece, another tubingattachment issue in medical apparatus is also addressed. As describedabove, tubing sets for ultrasonic aspirators consist of at least twolumens. One lumen has a smaller diameter intended to supply irrigationto the sterile field through the handpiece. The other lumen has a largerdiameter and is intended to provide a path for aspiration from thesterile field to a collection canister near the console. Tubing in thecommercial ultrasonic aspirators on the market is seen as difficult tohandle and assemble to the console due to the fact that the user has toknow how to align it in the pump and pinch valve at the console and theneed to have a secondary tubing assembly to connect to an IV bag. Toaddress this issue, an embodiment of the present invention provides atubing cartridge 80 as shown in FIG. 21A that allows alignment of bothsets of tubing, i.e., the irrigation tubing 822 and aspiration tubing824, in one motion on the console and has an integral IV bag spike or IVconnector 823 so a secondary tubing is not needed. FIG. 21B shows anassembly with the path of the irrigation and aspiration tubing withinthe cartridge 80. FIG. 21C shows an aspiration canister connector 825and an IV connector 823 on the right.

In terms of use, a sterile user would assemble the tubing set to thehandpiece in the sterile field. FIG. 22A shows a cartridge and tubingset. As shown in FIG. 22B, to assemble the tubing set to the handpiece812, the user should first pick up the larger loop of the irrigation andaspiration tubing set to be brought into the sterile field and assembledto the handpiece 812. The handpiece 812 has an electrical cable 826.Place the cartridge and smaller loop of the irrigation and aspirationtubing set aside until it is time to connect it to the console. As shownin FIG. 22C, attach the aspiration tubing 824 to the aspiration port atthe base of the handpiece. As shown in FIGS. 22D and 22E, attach theirrigation tubing 822 to the luer lock fitting on the handpiece fluetubing 818 of the flue 816. As shown in FIG. 22F, push the irrigationtubing and flue tubing 818 into the capture component or tubing clip 842at the base of the handpiece. The tubing clip allows for adjustment oflocation of the flue/irrigation tubing based on the desires of thesurgeon.

The remainder of the assembly would then be passed to non-sterilepersonnel for connection to the console, as shown in FIGS. 23A-23D. Inthe non-sterile area, a user opens the irrigation door 830 and align thecartridge 80 with runners 840, as shown in FIG. 23A. The user will thenpush the cartridge 80 down to align with the peristaltic wheel 850 andpinch valve 860 in one motion. This will also impart the appropriateamount of “stretch” on the irrigation tubing 822 to assure properfunction during use, as shown in FIG. 23B. The door 830 is then closedwhich secures the cartridge 80 and allows the backing wall 870 tocompress the tubing for proper function, as shown in FIG. 23C. Finalsteps are to connect the IV connector 823 and the aspiration canisterconnector 825 shown in FIG. 23D to an IV bag and an aspiration canister,respectively. The tubing cartridge allows the user to quickly connectthe tubing set to the console.

While several inventive embodiments have been described and illustratedherein, those of ordinary skill in the art will readily envision avariety of other means and/or structures for performing the functionand/or obtaining the results and/or one or more of the advantagesdescribed herein, and each of such variations and/or modifications isdeemed to be within the scope of the inventive embodiments describedherein. More generally, those skilled in the art will readily appreciatethat all parameters, dimensions, materials, and configurations describedherein are meant to be exemplary and that the actual parameters,dimensions, materials, and/or configurations will depend upon thespecific application or applications for which the inventive teachingsis/are used. Those skilled in the art will recognize, or be able toascertain using no more than routine experimentation, many equivalentsto the specific inventive embodiments described herein. It is,therefore, to be understood that the foregoing embodiments are presentedby way of example only and that, within the scope of the appended claimsand equivalents thereto, inventive embodiments may be practicedotherwise than as specifically described and claimed. Inventiveembodiments of the present disclosure are directed to each individualfeature, system, article, material, kit, and/or method described herein.In addition, any combination of two or more such features, systems,articles, materials, kits, and/or methods, if such features, systems,articles, materials, kits, and/or methods are not mutually inconsistent,is included within the inventive scope of the present disclosure.

All definitions, as defined and used herein, should be understood tocontrol over dictionary definitions, definitions in documentsincorporated by reference, and/or ordinary meanings of the definedterms.

The indefinite articles “a” and “an,” as used herein in thespecification and in the claims, unless clearly indicated to thecontrary, should be understood to mean “at least one.”

The phrase “and/or,” as used herein in the specification and in theclaims, should be understood to mean “either or both” of the elements soconjoined, i.e., elements that are conjunctively present in some casesand disjunctively present in other cases. Multiple elements listed with“and/or” should be construed in the same fashion, i.e., “one or more” ofthe elements so conjoined. Other elements may optionally be presentother than the elements specifically identified by the “and/or” clause,whether related or unrelated to those elements specifically identified.Thus, as a non-limiting example, a reference to “A and/or B”, when usedin conjunction with open-ended language such as “comprising” can refer,in one embodiment, to A only (optionally including elements other thanB); in another embodiment, to B only (optionally including elementsother than A); in yet another embodiment, to both A and B (optionallyincluding other elements); etc.

As used herein in the specification and in the claims, “or” should beunderstood to have the same meaning as “and/or” as defined above. Forexample, when separating items in a list, “or” or “and/or” shall beinterpreted as being inclusive, i.e., the inclusion of at least one, butalso including more than one, of a number or list of elements, and,optionally, additional unlisted items. Only terms clearly indicated tothe contrary, such as “only one of” or “exactly one of,” or, when usedin the claims, “consisting of,” will refer to the inclusion of exactlyone element of a number or list of elements. In general, the term “or”as used herein shall only be interpreted as indicating exclusivealternatives (i.e. “one or the other but not both”) when preceded byterms of exclusivity, such as “either,” “one of,” “only one of,” or“exactly one of.” “Consisting essentially of,” when used in the claims,shall have its ordinary meaning as used in the field of patent law.

As used herein in the specification and in the claims, the phrase “atleast one,” in reference to a list of one or more elements, should beunderstood to mean at least one element selected from any one or more ofthe elements in the list of elements, but not necessarily including atleast one of each and every element specifically listed within the listof elements and not excluding any combinations of elements in the listof elements. This definition also allows that elements may optionally bepresent other than the elements specifically identified within the listof elements to which the phrase “at least one” refers, whether relatedor unrelated to those elements specifically identified. Thus, as anon-limiting example, “at least one of A and B” (or, equivalently, “atleast one of A or B,” or, equivalently “at least one of A and/or B”) canrefer, in one embodiment, to at least one, optionally including morethan one, A, with no B present (and optionally including elements otherthan B); in another embodiment, to at least one, optionally includingmore than one, B, with no A present (and optionally including elementsother than A); in yet another embodiment, to at least one, optionallyincluding more than one, A, and at least one, optionally including morethan one, B (and optionally including other elements); etc.

It should also be understood that, unless clearly indicated to thecontrary, in any methods claimed herein that include more than one stepor act, the order of the steps or acts of the method is not necessarilylimited to the order in which the steps or acts of the method arerecited.

In the claims, as well as in the specification above, all transitionalphrases such as “comprising,” “including,” “carrying,” “having,”“containing,” “involving,” “holding,” “composed of,” and the like are tobe understood to be open-ended, i.e., to mean including but not limitedto. Only the transitional phrases “consisting of” and “consistingessentially of” shall be closed or semi-closed transitional phrases,respectively, as set forth in the United States Patent Office Manual ofPatent Examining Procedures, Section 2111.03.

The invention may be embodied in other forms without departure from thescope and essential characteristics thereof. The embodiments describedtherefore are to be considered in all respects as illustrative and notrestrictive. Although the present invention has been described in termsof certain preferred embodiments, other embodiments that are apparent tothose of ordinary skill in the art are also within the scope of theinvention.

1. A tubing attachment system for use with an ultrasonic surgicalapparatus having a handpiece and an aspiration tube to be connectedproximally to the handpiece, the tubing attachment system comprising: atubing clip having a frame having a front side and an opposing back sideand a longitudinal frame opening extending between the front side andthe back side, wherein the longitudinal frame opening is defined by aplurality of locking protrusions, each locking protrusion of theplurality of locking protrusions has a proximal end and a distal freeend, wherein the proximal end projects from the frame adjacent the frontside and the distal free end adjacent the back side, and wherein eachlocking protrusion of the locking protrusions includes a contact surfacenarrowing the longitudinal frame opening from the front side to the backside; and wherein the tubing clip includes one or more channels at aradial position away from the longitudinal frame opening configured tohold one or more tubes.
 2. The tubing attachment system of claim 1,wherein the one or more channels is defined by one or more arms.
 3. Thetubing attachment system of claim 1, wherein the contact surface facesinwardly and extends from the proximal end to the distal free end of thelocking protrusion.
 4. The tubing attachment system of claim 1, whereinthe one or more channels and the longitudinal frame opening are parallelto each other.
 5. The tubing attachment system of claim 1, wherein theplurality of locking protrusions are spaced circumferentially about thelongitudinal frame opening.
 6. The tubing attachment system of claim 1,further comprising a tubing attachment component having a longitudinalthroughbore and a circumferential groove on an external frame surface,the tubing attachment component including a proximal end portionconfigured to attach to the aspiration tube and a distal end portionconfigured to attach to the handpiece.
 7. The tubing attachment systemof claim 6, in combination with an ultrasonic surgical apparatus havinga handpiece and an aspiration tube connected to the proximal end portionof the tubing attachment component.
 8. The tubing attachment system ofclaim 6, wherein the tubing attachment component further comprises atleast one flange extending from the external frame surface of the tubingattachment component to define a longitudinal extent of thecircumferential groove.
 9. The tubing attachment system of claim 8,wherein the frame between the front side of the frame and the distalfree ends of the plurality of locking protrusions are longitudinallyheld between the longitudinal extent of the circumferential groove ofthe tubing attachment component while allowing rotation of the tubingclip about the tubing attachment component.
 10. A tubing attachmentsystem comprising: a tubing clip having a frame having an internal framesurface, an external frame surface, and a frame opening defining alongitudinal axis, the frame including at least one locking protrusionextending inward from the internal frame surface, and wherein the atleast one locking protrusion defines the frame opening; and one or moretube retaining arms extending outwardly from the frame.
 11. The tubingattachment system of claim 10, wherein the tubing clip has a pluralityof the at least one locking protrusion disposed on the internal framesurface of the frame.
 12. The tubing attachment system of claim 10,wherein the at least one locking protrusion includes a first contactsurface facing inwardly that extends from a proximal end to a distalfree end of the at least one locking protrusion.
 13. The tubingattachment system of claim 12, the at least one locking protrusionincludes a second contact surface at the proximal end facing axiallyaway from the frame in a direction along the longitudinal axis.
 14. Thetubing attachment system of claim 10, wherein the one or more tuberetaining arms form a channel configured to hold another tube.
 15. Thetubing attachment system of claim 10, further comprising a tubingattachment component having a proximal end, a distal end, and anexternal surface, the tubing attachment component comprising a proximalend portion configured to attach to the tube, a distal end portionconfigured to attach to the handpiece, a throughbore extending from thedistal end to the proximal end, and a circumferential groove on theexternal surface between the proximal end portion and the distal endportion; wherein the frame and the at least one locking protrusion areconfigured to fit in the circumferential groove and be rotatable in thecircumferential groove about the tubing attachment component when anexternal force is applied and to frictionally lock the tubing attachmentcomponent in a desired rotational position in the absence of suchexternal force; wherein the proximal end portion includes a conical bodytransitioning into a radially outwardly extending barb for securing thetube, and the distal end portion includes a fitting for engaging acorresponding fitting on the handpiece; and wherein the tubingattachment component further comprises a flange between the conical bodyand the fitting, and the flange forms a rail of the circumferentialgroove.
 16. The tubing attachment system of claim 10, in combinationwith a medical apparatus, wherein the medical apparatus is an ultrasonicsurgical apparatus.
 17. A medical apparatus comprising: a handpiece anda tube, wherein the tube is connected to the handpiece through a swiveljoint which allows the tube to rotate circumferentially with respect tothe handpiece without axial displacement of the tube; and wherein theswivel joint further comprises: a tubing attachment component having alongitudinal throughbore and a circumferential groove on an externalframe surface, wherein a bottom wall of the circumferential grooveincreases in depth towards the longitudinal throughbore; and a tubingclip having a frame with a frame opening and at least one lockingprotrusion having a contact surface facing inwardly and narrowing theframe opening along the longitudinal axis, wherein the contact surfaceof the at least one locking protrusion contours to and frictionallyengages the bottom wall of the circumferential groove of the tubingattachment component; wherein the frame can be snapped into thecircumferential groove of the tubing attachment component and rotateabout the tubing attachment component; and wherein the at least onelocking protrusion allows the tubing clip and tubing attachmentcomponent to be fixed at a desired relative position.
 18. The medicalapparatus of claim 17, wherein the tubing clip includes a plurality ofthe at least one locking protrusion extending radially inward from aninternal frame surface of the frame.
 19. The medical apparatus of claim17, wherein the contact surface of the at least one locking protrusionextends from a proximal end to a distal free end of the at least onelocking protrusion.
 20. The medical apparatus of claim 17, wherein thetubing attachment component further comprises a flange extending fromthe external frame surface of the tubing attachment component anddefining a longitudinal extent of the circumferential groove.
 21. Themedical apparatus of claim 17, wherein the tubing clip further comprisesone or more arms extending outwardly from an external frame surfaceforming one or more channels for holding another tube.
 22. The medicalapparatus of claim 17, which is an ultrasonic surgical apparatus andwherein the tube is an irrigation tube or an aspiration tube.